Amputations and foot-related hospitalisations disproportionately affect dialysis patients

Int Wound J. 2015 Oct;12(5):523-6. doi: 10.1111/iwj.12146. Epub 2013 Sep 19.

Abstract

Patients with diabetes have increased risk for foot ulcers, amputations and hospitalisations. We evaluated a closed cohort of patients with diabetes and established risk factors in two high risk groups: (i) dialysis patients and (ii) patients with previous foot ulceration. We used claims data for diabetes (ICD-9 250.X), ulceration (ICD-9 707·10, 707·14 and 707·15) and dialysis (CPT 90935-90937) from the Scott and White Health Plan to identify 150 consecutive patients with diabetes on dialysis (dialysis group) and 150 patients with a history of foot ulceration (ulcer history group). We verified these diagnoses by manually reviewing corresponding electronic medical records. Each patient was provided 30 months follow-up period. The incidence of foot ulcers was the same in dialysis patients and patients with an ulcer history (210 per 1000 person-years). The amputation incidence rate was higher in dialysis patients (58·0 versus 13·3, P < 0·001). Hospital admission was common in both study groups. The incidence of hospitalisation was higher in the ulcer history group (477·3 versus 381·3, P < 0·001); however, there were more foot-related hospital admissions in the dialysis group (32·9% versus 14·0%, P < 0·001) during the 30-month evaluation period. The incidence of ulcers, amputations and all-cause hospitalisations is high in persons with diabetes and a history of foot ulceration or on dialysis treatment; however, those on dialysis treatment have disproportionately higher rates of foot-related hospitalisations. Intervention strategies to reduce the burden of diabetic foot disease must target dialysis patients as a high-risk group.

Keywords: Amputation; Diabetes; Dialysis; Epidemiology; Ulcer.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amputation / statistics & numerical data*
  • Case-Control Studies
  • Diabetic Foot / epidemiology*
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Recurrence
  • Renal Dialysis*
  • Renal Insufficiency / complications*
  • Renal Insufficiency / therapy
  • Risk Factors